Frequently Asked Questions

You can look through our Frequently Asked Questions (FAQs) to
learn more about applying for health coverage. Click
here for additional FAQs about the New York Health Plan
Marketplace, Individuals & Families, Small Businesses,
Brokers, and Navigators.

General FAQ

What is New York State of Health?

New York State of Health is a new Health Plan Marketplace.
Individuals, families, and small businesses can use it to buy
health insurance. It lets you shop and compare many health plans.
It is the only place to get help lowering the cost of health
coverage.

Who can use the Marketplace?

New York State of Health can be used by individuals,
families and small businesses with 100 or fewer employees.
Everyone should come to the Marketplace to see what it can offer.

How is New York State of Health different from other
online marketplaces?

New York State of Health is a state-of-the-art website. It
lets you shop for, compare, and buy a health plan online, in
person or over the phone. Small employers can set a fixed amount
to pay toward employee health plans. They can also provide a
choice of health plans. We offer expert "helpers" for every step
of the process. The Marketplace is the only place you can get tax
credits to help lowering the cost of a health plan.

Where can I get help understanding health insurance
terms?

Visit the glossary page on this web site. It
contains many common terms that are helpful to know.

When was the Marketplace established?

New York State of Health was launched In April of 2012. Governor
Cuomo issued an order
to set up a statewide Health Plan Marketplace.

How is New York's Marketplace funded?

New York State of Health is funded by the federal
government. It has to be able to support itself by 2015.

What grants has New York State received to support the
Marketplace?

New York has received federal grants to build and roll out New
York State of Health. To learn more, see the Resources page of
this website under "Grants."
.

Individuals & Families FAQ

Why should I buy a health plan through the Marketplace?

Because you will benefit from the great features listed
below. All of them are found only at New York State of Health:

Choice and Value: Compare health plans side-by-side to
find the right one for you.

Financial Support: See if you can get help reducing the
cost of your premiums.

In-Person Assistance: Enroll with the help of experts
who are trained and certified by New York State of Health.

Where can I get help to understand my insurance options
in the Marketplace?

NY State of Health certified experts are able to guide you
through the enrollment process. They can help you enroll
in a health plan that is right for you based on your needs.
They can also help you figure out if you can get help
reducing the cost of coverage. You can get help online,
in person where you live or work, and by phone. You pick
what works best for you. Click here to find one of our
experts who can help you.

Can I buy insurance through the Marketplace if I already
have a serious health problem?

Yes. The amount you pay for a health plan will not be
affected by your health status. This means that you cannot be
charged more because of your health problem. It also means you
will not have to wait to get the coverage you need.

What if I choose to go without health insurance coverage?

People who do not get a health plan may have to pay a tax
penalty to the federal government. But in some cases, the penalty
will not have to be paid. To learn more, talk to one of our
helpers.

Who can get coverage through the Marketplace?

To shop in the Marketplace, you:

Must live in New York

Must be a US citizen, national, or lawfully present
immigrant (Different immigration rules may apply if you are
eligible for Child Health Plus or NYS Medicaid based on your
income)

Cannot be currently incarcerated

What if I speak or read in a language other than English?

New York is a diverse state with many people that may speak
or read in a language other than English. Call the Marketplace at
1-855-355-5777 for more information or help applying for coverage
in your language. All help is free.

Why do I need to provide a Social Security number (SSN)?

The Marketplace needs Social Security numbers for everyone who
has one and is applying for health insurance. We use SSNs to
check federal and state data sources to help speed up the
application process. Providing your SSN can be helpful even if
you do not want health coverage. If you don't have a SSN, call
the Social Security Administration at 1-800-772-1213 or visit www.socialsecurity.gov
to see if you can get a SSN and to apply for one.

Can I give someone else permission to get information
about my application?

Anyone can call us to ask general questions, but we cannot
discuss specific information about your application with anyone
else, unless you give us permission to do so. You can give a
trusted friend, relative, partner, or lawyer permission to talk
with us about your application, and to act for you on matters
related to your application. This person is called an authorized
representative. You can call 1-855-355-5777 to find out how to
name someone as your authorized representative.

What do I need to apply for coverage through the
Marketplace?

We ask about income and other information about you to tell
you what coverage you qualify for and if you can get help paying
for it. We keep all of the information you provide private, as
required by law. For everyone applying for help paying for your
health insurance through the Marketplace, things you should know:

Information about any ob related health insurance
available to your family

Who should I include on my application?

Your income and family size help us decide what programs
you qualify for. Include these people on your application for
health coverage:

Yourself

Your spouse, if you're married

Any children you are caring for who live with you

Your partner, who lives with you

Anyone you include on your federal income tax return

You do not have to file taxes to apply for health insurance
coverage for the Marketplace. Anyone else who lives with you will
need to file their own application if they want insurance. Not
everyone has to be living at the same address to apply on the
same application.

Why does the Marketplace ask about race and ethnicity?

As part of the health insurance application process, there
are optional questions about each applicant's race and ethnicity.
You do not have to answer these questions, but answering them can
help us serve your community better. Giving us this information
will not affect your eligibility, plan choices, or access to
programs.

What benefits do American Indians or Alaska Natives get
through the Marketplace?

American Indians and Alaska Natives recognized by the U.S.
government may qualify for special health care cost-sharing and
other benefits as a result of the Affordable Care Act. These
include:

No cost sharing such as deductibles or copayments if the
household income is below 300% of the federal poverty level and
the individual is enrolled in a qualified health plan in the
Marketplace

The ability to change a health plan once per month, if
they are enrolled in a qualified health plan

Exemption from the individual responsibility payment if
they do not maintain health insurance coverage.

Can I still get health insurance if I am disabled or
chronically ill?

You may still qualify for health insurance if you are
disabled or chronically ill. Chronically ill persons include
persons who cannot work for at least 12 months because of an
illness or injury. They also include persons who have an illness
or disability that has lasted or is expected to last for at least
12 months. The Marketplace will make sure that you get the right
services. This may involve referring your application to our
Local Departments of Social Services for additional assistance.

What is the Family Planning Benefit Program?

The Family Planning Benefit Program (FPBP) provides family
planning services from any family planning service provider who
accepts Medicaid. Some individuals with private health insurance
may need to keep their family planning services confidential.
Those people may enroll in FPBP if they meet eligibility
requirements.

What is the Address Confidentiality Program?

The Address Confidentiality Program is administered by the
Department of State for victims of domestic violence. To learn
more about this program, visit http://www.dos.ny.gov/acp/.

I am moving to New York in the next few months. Can I
apply for health insurance in New York now?

You can apply for health insurance through the Marketplace
if you are moving to NYS for a job or to find a job within the
next 90 days. However, you cannot enroll into a health plan until
you have moved to New York State and have told us your NYS
address. You can update your address by logging into your
Marketplace account or calling us at 1-855-355-5777.

Can I still apply for health coverage through the
Marketplace if I have other insurance?

You and your family may still be eligible for health
coverage even if you have other health insurance. Based on the
information you tell us about your other insurance, the
Marketplace will see if you can get help paying for your health
insurance coverage.

Do I have to file taxes to get help paying for health
insurance?

Each program has its own rules regarding filing taxes. One
of the eligibility criteria for an advanced premium tax credit is
that you must file taxes, and if married, you must file jointly.
To determine which program you and your family may be eligible
for, we need to know about the filing status of everyone on your
application for the upcoming tax year. If someone is married and
will file jointly, we need to know who they will file with. We
will also need to know about dependents whom you plan to claim.
You also need to let us know if you or other household members
will not be filing taxes. To be eligible for an advanced premium
tax credit, you must file taxes, and if married, you must file
jointly.

We need to ask about marital status and tax filing status as
part of the application process. To qualify for the premium
tax credit, most married individuals applying through the Marketplace
must file their federal taxes jointly. However, there may be situations
when married individuals may qualify without filing taxes jointly.
You may qualify for a premium tax credit if you were legally separated
by the end of the year, and you have a court decree of separate
maintenance or divorce. Signing and filing a separation agreement
with the court is not a decree. You may also qualify for the premium
tax credit if you are married but live apart from your spouse
and meet the requirements to file as Head of Household. You
should consult a tax advisor or the Internal Revenue Service to
determine whether your situation exempts you from the requirement to
file jointly to receive a premium tax credit. If you are in one of these
situations, call the Marketplace at 1-855-355-5777 for more information.

Can I still get a tax credit if I will be claimed as a
dependent on another person's tax return?

Eligibility for advanced premium tax credits is based on a
variety of factors, including tax filing status. If you will be
claimed as a dependent on another person's tax return, the income
of everyone on that tax return will be considered in determining
eligibility. You cannot get an advanced premium tax credit on
your own if you will be claimed as a dependent on another
person's tax return.

Why does the Marketplace need to know how much money I
make?

Eligibility for help paying for health insurance is based
on a variety of factors, including how much money you plan to
make in the upcoming year. This includes income from a job as
well as other types of income, such as unemployment benefits and
Social Security.

I recently dropped my employer coverage because it was
too expensive. Is my child still eligible for Child Health Plus?

Children who were previously covered by employer based
coverage that was voluntarily dropped may be subject to a 90 day
waiting period before they can enroll in Child Health Plus unless
the child meets one of the waiting period exceptions.

Can my child still enroll in Child Health Plus if I have
health insurance through the New York State Health Insurance
Program (NYSHIP)?

State Health Benefits Plans provide health insurance
through the New York State Health Insurance Program (NYSHIP).
Coverage is offered to employees/retirees of NYS government, the
State Legislature and the Unified Court System. Some local
government agencies and school districts also elect to
participate in NYSHIP. If you are not sure, check with your
employer. If your child has access to State Health Insurance
Benefits through NYSHIP, he/she will not be able to enroll in
Child Health Plus.

Do I qualify for premium tax credits if my employer
offers a health plan that meets minimum value standard?

An employer-sponsored health plan meets "minimum value
standard" if the health plan's share of the total allowed benefit
costs covered by the plan is no less than 60 percent of those
costs. If your employer offers a health plan that does meet
minimum value, then you do not qualify for premium tax credits.

Can I still apply for health coverage through the
Marketplace if my employer offers health insurance?

You can still apply for health insurance through the
Marketplace if your employer offers health insurance. If the
insurance offered by your employer does not meet minimum value or
is unaffordable, then you may be eligible to get premium tax
credits to help pay for the health insurance you purchase through
the Marketplace. Minimum value means that the health plan's share
of the total allowed benefit costs covered by the plan is no less
than 60 percent of those costs. Unaffordable, in this context,
means that the employee's share of the premium for the employer's
self-only plan is more than 9.5% of the employee's household
income.

Am I eligible for health insurance if I am incarcerated?

If you are incarcerated (except for pending disposition), you are
not eligible to purchase health insurance through the
Marketplace. You may, however, be eligible for public health
insurance programs, such as Medicaid during this time. During
incarceration, Medicaid coverage is limited to inpatient
hospitalizations provided off the grounds of the correctional
facility. The correctional facility is responsible for all other
medical care and treatment provided to you.

What if I cannot afford to buy health insurance, or I
don't want to buy health insurance for another reason?

Certain people may qualify for an exemption from the
federal mandate to have health insurance. If you are approved for
an exemption, you will not have to pay a penalty to the Internal
Revenue Service for not having health insurance. You can find out
information about Exemptions in the Marketplace.

I hardly ever get sick. Is there a health insurance plan
that just provides coverage for major illnesses?

People who are under age 30 and some people who cannot
afford to buy a more comprehensive health insurance plan may buy
a type of health insurance plan called “catastrophic coverage.”
Catastrophic health plans have lower monthly premiums than
traditional health insurance plans, but have much higher
out-of-pocket costs. If you are over age 30, you will first need
to be approved for affordability hardship exemption. You can find
out more information in the Marketplace.

What is the premium tax credit?

The premium tax credit is the financial assistance provided
by the federal government to help you and your household pay the
monthly premium for the qualified health plan you enroll in the
Marketplace. This assistance is only available to health plans in
the market place.

How can I use the premium tax credit?

The premium tax credit can be used "in advance." This means
that the federal government will send the amount of the premium
tax credit you choose to use to help pay for your qualified
health plan’s monthly premium. If the advance premium tax credit
does not cover all of the monthly premium, then you will pay for
the remaining amount. You can choose to use all, some, or none of
the tax credit. If there are household members that want to
enroll in different plan, you can allocate the amount of the tax
credit across the household members.

How will changes in my income or family size affect my
premium tax credit?

Changes in your income and family size during the coverage
year may increase or decrease the premium tax credit you qualify
for. When you file your federal income taxes for this year, the
IRS will look at the annual income provided on your taxes and
compare it to what you told us in this application that you
expect your income to be for the year. Since the premium tax
credit you get depends on your annual income, the IRS looks at
the premium tax credit you took in advance and compares it to
what you are eligible to take when you file your taxes.

If the advance premium tax credit you get for the year is
less than the tax credit you are entitled to when you file taxes,
you will get the difference as a refundable credit when you file
your federal income tax return.

If your advance payments for the year are more than the
amount of your credit you are eligible for, you must repay the
excess advance payments with your tax return. If you experience
any changes in your income or family size, you should update your
Marketplace account or call customer service at 1-855-355-5777.

How can I find a health plan in the Marketplace for
myself or for my household member(s)?

Based on the health insurance program that you and/or your
household members qualify for, the Marketplace will show you the
health plans that you can choose from. We will provide you
information about the health plan including , the monthly
premium, metal level, type (i.e., medical or dental), cost
sharing such as deductibles or out of pocket costs, covered
benefits and services, and their quality rating.

Can I search for doctors, hospital, or facility in the
health plan's network?

Yes - You can search to see if your current doctors or
facilities where you receive health care services are part of a
plan's network of providers. Sometimes, the plans that your provider
accepts, or the “network” they are in, will change.
It is always best to check with your provider and the health plan first.
We strongly encourage you to call your doctors, hospitals, other facilities,
and the health plans directly before completing the plan selection process.

Can my household members be in the same or different
health plan?

You and your household members may be in the same or
different health plan, depending on how you want to cover them
through the health plan. For example, a couple can choose to
enroll in the same health plan for simplicity or be in different
plans because each person may have different health care needs.
The cost of premiums and cost-share sharing will vary based on
the option that you select.

How do I pay the health plan premium?

You must pay the first month's premium in order for your
coverage to be effective and to start using health care services.
The Marketplace does not accept premium payments for the health
plans for individuals and families. Your health plan will send
you information about how to pay this premium or you can contact
them directly.

What are the plan "metal levels" ?

The Marketplace offers four major types of qualified health
plans - Bronze, Silver, Gold, and Platinum. Each plan type
differs in the percentage of health care costs that a plan would
pay for an average person. For example, the Bronze level plan
will pay for 60% of all health care costs for an average person
and individuals that enroll into this plan level will pay for 40%
of the costs. Health plans in the Platinum level will cover 90%
of the health care costs and the individual will have to pay for
the remaining 10%.

What if I disagree with a determination made by the
Marketplace?

You can call us at 1-855-355-5777 (TTY: 1-800-662-1220) to
discuss your concerns and we will do our best to help you. If you
are not satisfied with the result of the informal resolution
process you may request a formal appeal, if the time limit for
requesting an appeal has not ended. Or you can ask us for an
appeal without using the informal resolution process.

What is an appeal?

An appeal is a formal request to have a review of your
eligibility determination because you do not agree with the one
the Marketplace made. You can request an appeal for yourself and
anyone in your household who also applied for health insurance.

Once you request an appeal, the Marketplace will schedule a
hearing. A hearing is a formal conversation where you will have
the opportunity to explain why you disagree with the eligibility
determination we have made. An impartial hearing officer will
conduct your hearing. If you have documents that you think would
help your appeal, you can submit them for the hearing. During the
hearing, you can also explain why you think we made a mistake.

The amount of financial assistance you will receive
toward your out-of-pocket expenses when you use health care
services

A denial for a special enrollment period; and

Whether we made a timely eligibility determination

Where do I go to appeal a decision about my health care
services?

The Marketplace cannot accept appeals about health care
services such as the types of health care benefits your plan
offers, access to doctors or specialists, or a denial of prior
authorization for services.

If you have Medicaid, please contact the Office of
Administrative Hearings at www.otda.ny.gov/oah/ or at
1-800-342-3334 to appeal coverage decisions.

If you have Child Health Plus or are enrolled in a
qualified health plan, please contact your health plan to appeal
coverage decisions. Information on health insurance complaints
and appeals can be found on the Department of Financial Services
website at http://www.dfs.ny.gov/consumer/chealth.htm

Are there time limits to file an appeal request?

Yes, there are time limits. Generally, you have 60 days to
request an appeal. Once the Marketplace has received your appeal
request, we will review it and let you know what happens next.

Where do I go for my hearing?

We conduct all hearings by telephone and will call you at
the telephone number(s) you provided in your Marketplace account.
If you want us to call you at a different number, you may give us
that number in your Marketplace account or when you call us to
request the hearing.

When you request a hearing, you can let us know which day
of the week and time (morning or afternoon) is convenient for
you. We will do our best to schedule your hearing on the day and
time that works for you. After we receive your appeal request, we
will send you a scheduling notice to let you know when we will
call you for your hearing.

What if I need special assistance or accommodations for
my hearing?

You can request for special assistance or accommodations
for your hearing. This includes language assistance (such as
translation from English to another language) and accommodation
for any hearing impairment.

Can I have someone help me at my hearing?

Yes. You can have a lawyer, relative, or friend help you
during the appeal process. If you think you need a lawyer, you
might find one at no cost by calling your local Legal Aid, Legal
Services Office, or local Bar Association. You can also represent
yourself.

If you want help during your appeal, you can designate a
person or an organization to act as your authorized
representative. Your authorized representative receives the same
appeal notices and other communications that you do.

What can I do after I submit my appeal request?

While you are waiting for your hearing to be scheduled, we
can help you try to resolve your problem informally. You can also
provide new information or documents that will help us understand
your concerns during the informal process. To do so, you can call
us at 1-855-355-5777. If we have resolved your concerns during
this informal process, we will then work with you to withdraw the
request.

Can I continue my coverage during the appeal process?

Yes, but it is optional. If you are enrolled in a Medicaid,
Child Health Plus or a qualified health plan, you may be able to
continue the same coverage or amount of financial assistance
during the appeal process. Financial assistance includes aid you
received to pay for your health insurance premiums or to reduce
out-of-pocket costs when you use health care services.

If you have Medicaid, you need to act quickly. You have ten
(10) days from the date of your eligibility determination notice
to ask us to have your Medicaid continued during your appeal
process.

How will the appeal decision affect me or other people in
my household?

Depending on the appeal decision, you may have to repay
some or all of the financial assistance you received during the
appeal process. If we determined other people in your household
eligible for health insurance through the Marketplace, their
eligibility may also change. The Marketplace will let you know of
the changes and redetermine the eligibility for you and your
household, if applicable.

What do I do if I no longer want to appeal?

If you have requested an appeal and feel it is no longer
necessary, you may withdraw your appeal request. Call the
Marketplace at 1-855-355-5777 to learn how to withdraw.

Small Business Marketplace FAQ

Who can buy health insurance coverage through the Small
Business Marketplace?

New York State of Health is for small businesses with 100 or
fewer Full time equivalent employees (FTEs).

Why should I buy health insurance for my employees
through the Marketplace?

Small business owners can benefit from all the features
listed below. Each is found only at New York State of Health:

Choice and Value: You have many health plans and prices
to pick from. You can also choose how much to pay toward
employee's coverage, and when you want it to start.

Tax Benefits: You may be able to get a tax credit for
the amount you pay toward your employee's premiums. It can cover
as much as 50 percent of that cost.

Defined Contribution: Small employers can set a fixed
amount to pay toward employee coverage.

In-Person Assistance: Small businesses and their
employees can receive in-person help with enrollment. This help
will come from brokers, agents, and other in-person "helpers"
trained and certified by New York State of Health.

Simplicity: One account, online enrollment and one
monthly bill, even if employees choose different health plans.
All these things take away the most difficult and time-consuming
parts of providing health insurance.

How can I contact a "helper" to assist me in
choosing the right health plan for my business?

You can get help in 3 different
ways. Our experts will walk you through your choices:

What can I do now to prepare to shop on the Marketplace?

Think about your coverage needs and those of your
employees. Does your current health plan meet those needs?

Ask yourself what benefits you'd like to give your
employees and the amount you are willing to pay toward a health
plan.

Talk with your insurance broker and discuss how he or
she can help you make the best choices for your business and
your employees.

Consult your tax advisor to see if you can get the Small
Business Health Care Tax Credits.

Do I have to contribute to employees' health insurance
through the Marketplace?

No. There is no minimum amount you must contribute toward
your employees' health insurance at New York State of Health.

Does the Marketplace collect payments from small business
owners or employees to pay for health insurance coverage?

New York State of Health collects premiums from small
business owners and pays the carriers directly. Employers
continue to collect premiums from their employees.

Can I choose when my employees' insurance coverage takes
effect?

Yes. The coverage effective date can be as early as January 1
or on the first of any month after January.

How will I know if my small business is eligible for the
Small Business Health Care Tax Credit?

Businesses with up to 25 employees that provide health
insurance and pay an average annual wage of less than $50,000
(not including the owner's salary) may qualify for the Small
Business Health Care Tax Credit. It can be up to 50% of their
share of employee premiums. Or up to 35% for nonprofits. New York
State of Health will be the only place you get the Small Business
Health Care Tax Credit. Employers may also consult their tax
advisor.

How lengthy is the Small Business Marketplace
application?

The online application will take about 30 minutes to
complete. This includes the time required to upload a list of
employees, select health plans and decide how much you will pay
toward your employees' insurance. Your insurance broker can help
you with the application provided that he or she is certified by
the Marketplace.

When enrolling through the website, can I save my
application and come back later?

Yes. The website lets you fill out part of the form and
then save it. You can come back later if you are not able to
complete the form in one sitting.

Will the Marketplace be open to other employers in the
future?

For the first 2 years, only businesses with 50 or fewer
employees can use New York State of Health. In 2016, it will open
to larger businesses with 100 or fewer employees.

Brokers FAQ

Can brokers receive commission?

Yes, commissions will come directly from carrier and will
vary based on company commission rules.

Do small businesses need to buy through the Exchange to
be eligible for tax credits?

Are there any minimum participation requirements?

Which Exchange covers sole proprietors?

Can a small business with employees outside New York
State purchase on the Exchange?

Yes, provided the business is headquartered in New York
State.

Is there one application for all carriers?

Yes.

Is there a minimum contribution required for employers?

No.

Navigators

What is an In Person Assistor/Navigator?

An In Person Assistor (IPA)/Navigator is a person trained
to educate and provide enrollment assistance to individuals and
small businesses about the health insurance options available
through New York’s Health Plan Marketplace, NY State of Health
(NYSOH). You can find an IPA/Navigator on
this page.

Who does the IPA/Navigator work for?

IPAs/Navigators work for various agencies that received
grants from the NYSOH to provide education and application
assistance. These include community based organizations,
hospitals, clinics and other human service agencies.

Who can an IPA/Navigator help?

IPAs/Navigators can assist individuals and families, as
well as small businesses and their employees.

What kind of training does an IPA/Navigator have?

A person must complete an intensive training course and
pass a qualifying exam before being certified as an
IPA/Navigator.

Will my information be kept confidential?

There are very strict privacy and confidentiality laws that
prohibit the disclosure of personal, financial and health
information to anyone, except to the NYSOH as authorized by the
applicant for the purpose of determining eligibility for and
enrollment into programs available through the Exchange.

Does it cost anything to apply through an IPA/Navigator?

No, IPA/Navigator services are free.

Are there IPA/Navigators who can assist non-English
speaking people?

IPA/Navigator services are available in many languages.
Many Navigators speak languages other than English, or the
community-based organization itself may employ bilingual staff or
offer Language Line services. Contact the IPA/Navigator agency on
your county for specific information on the availability of
assistance in a specific language.

Are IPA/Navigators available after regular working hours?

IPA/Navigators are available in every county, in convenient
community-based locations, and during non-traditional hours, such
as evenings and weekends. Contact the Navigator Agency in your
county for specific information on their days and hours of
operation.

Do I need to make an appointment or can I simply walk in?

IPA/Navigator may have different scheduling methods, so it
is best to contact the agency in your area to determine if you
need an appointment. Many of the sites accommodate walk-ins if an
IPA/Navigator is available at that time.

What if I have a problem after I enroll. Can the
IPA/Navigator help me?

The Navigator will be able to give you referral information
on how to file a grievance or complaint, or obtain assistance
with questions on your health plan, coverage or program
eligibility.

Privacy/Security

What should I do when I am done browsing the Marketplace
web site through a public computer?

Public computers in libraries, Internet cafes, airports, and copy
shops can be safe if you follow a few simple rules when you use
them so please consider the following when accessing the
Marketplace web site ; Don't leave the computer unattended with
sensitive information on the screen and please log out and
close the Internet browser prior to leaving this computer
.

Technical

What are the browsers supported by the Marketplace web
site?

The Marketplace web site was tested with the following
browsers:

Internet Explorer - 8, 9

Safari - 5, 6

Google Chrome - 18, 19

Mozilla Firefox - 12, 13

What to do if I get a time out or error page?

You should close your browser and login using a new browser
window.

If a page times out or gives an error, do I lose my data
that I have already saved?

All the data you entered before a time out or error
occurred would have been saved in the database and is not lost.
Once you can log back into the application, you should be able to
see your saved data.

How do I refresh/reload a page in the NYSOH Marketplace?

You can refresh your page by pressing Ctrl and F5 keys
simultaneously on the key board. The refresh will guarantee that
if the content is changed, you will get the new content. Please
note just pressing F5 may give you the old page, without showing
your new information.

Enrollment FAQ

What is open enrollment?

Open enrollment is the time period when you can apply for a
health plan through NY State of Health. You can learn
more on this page.

How can I apply?

You can apply online, by phone, in person or by mail.
There are NY State of Health certified experts to
provide in-person help for filling out your forms.
You can find one on this page.

When enrolling through the website, can I save my
application and come back later?

Yes. The website lets you fill out part of the form and
then save it. You can come back later if you are not able to
complete the form in one sitting.

How long will it take me to apply?

Filling out the forms online will take about 45 minutes.
Applying over the phone will take 45 minutes to 1 hour. If you
are not requesting financial assistance, it will not take as long
to complete the application.

What kind of information do I need to give when I apply?

You will need to provide facts about the people in your
household and their income. We will also ask for your name,
address, phone number, and social security number. If you have
access to other health insurance, you must state that.

Can I search for doctors, hospital, or facility in the health plan's network?

Yes - You can search to see if your current doctors or
facilities where you receive health care services are part
of a plan's network of providers. Sometimes, the plans that
your provider accepts, or the “network” they are in, will change.
It is always best to check with your provider and the health plan
first. We strongly encourage you to call your doctors, hospitals,
other facilities, and the health plans directly before completing
the plan selection process.

Can I change my plan if I am not satisfied with the health plan’s network?

If you are not satisfied with your qualified health plan, you can
change plans during the Open Enrollment Period. For coverage starting
in 2014, the Open Enrollment Period is October 1, 2013–March 31, 2014.
For coverage starting in 2015, the Open Enrollment Period is November 15,
2014–February 27, 2015. To switch plans during other times of the year,
you will need to qualify for a Special Enrollment Period.
Click here to learn more.

For the Medicaid program, you will have 90 days from the effective
date of your health plan enrollment to change your plan for any reason.
You can only change plans if there is another health plan available in
your area. After 90 days, you will not be able to change your health plan
for the rest of the coverage period, unless you have a good reason.

Children in the Child Health Plus program can change plans at any time.

Cost FAQ

Will the Marketplace make coverage more affordable for
individuals and families?

Yes. Even the highest level plan for individuals in the
Marketplace (platinum or gold) costs less than half of what
consumers used to pay when they bought insurance on their own.
Costs are so much lower now because of the large number of people
expected to buy insurance in the Marketplace. And for people with
a low enough income, costs will be reduced even more. That is
because of the help they get paying for their insurance.

Will the Marketplace offer affordable coverage to small
businesses?

Yes. Small employers and their employees will experience
affordable rates. The Marketplace's approved 2014 small business
plan rates can't be accurately compared to the 2013 rates because
of changes to the insurance market. In 2013, insurers offered
more than 15,000 different small group plans that significantly
varied in terms of the quality and level of coverage provided.
For 2014, insurers are offering standardized contracts and
product offerings within metal tiers (bronze, silver, gold, and
platinum). Also, a number of small businesses will be eligible
for tax credits that will lower those premium costs even further.

How will I know if I can get help paying for my health
insurance coverage?

Just come to the Marketplace. We will tell you if your income
qualifies you to get this kind of help.

One way the Marketplace helps with cost is in the form of
tax credits. What are tax credits?

With most tax credits, you have to wait until you file your
taxes to get the credit. But the new tax credit available through
the Exchange will allow you to reduce your costs right away.
People who qualify can take the tax credit in the form of advance
payments directly to their health plan to lower their monthly
health plan premiums starting in 2014. This will help make
insurance more affordable because you will pay less each month.

What is cost-sharing help? How do know if I qualify?

"Co-pays" and "coinsurance" are the part of a medical bill
that are charged to you, not your insurance company. A
"deductible" is the total you must pay in health costs
before your insurance kicks in. At New York State of Health, you
may get help paying these extra costs if your income falls below
a certain point. When you apply for a health plan, we will tell
you if you can get this kind of help.

How much do I have to pay for my insurance coverage?

The cost of coverage varies based on many things, including your
income and the plan you select. You can view the cost of health
plans available to you and estimate the financial help you
could receive through the "View Plans Now" tool
on this page.

Sole Proprietors FAQ

Who is considered a sole proprietor?

Sole proprietors are businesses that do not have at least
one eligible employee. An eligible employee is any employee who
works an average of 20 hours a week each month. A sole
proprietor's husband or wife is not considered an eligible
employee.

I am a sole proprietor. How do I buy health insurance
coverage in the Marketplace?

Sole Proprietors will shop for, compare and buy health
insurance coverage through the Individual Marketplace. Sole
proprietors may be eligible for financial assistance to reduce
the cost of coverage. Sole proprietors will not be eligible to
purchase coverage through the Small Business Marketplace.

How will the Marketplace serve people who speak languages
other than English?

Marketplace Customer Service Center Representatives and
In-Person Assistors/Navigators, who guide consumers through
the process of shopping for and enrolling in health insurance,
will help consumers in their language. Customer
Service Center Representatives who are available by phone can
accommodate more than 170 languages through bilingual staff
and translation assistance. In-Person Assistors/Navigators speak
the languages spoken in the communities they serve.

Will the Marketplace provide written materials in
languages other than English?

Yes, in addition to English, you are able to get NY
State of Health written materials in the languages spoken
most by New Yorkers. Health plans must have written
materials in other languages when 5% of people applying for
coverage in a county do not speak English as a first language.
You are also able to get someone to help translate or
interpret information for you.

Benefits FAQ

What are essential health benefits?

These are the 10 key health services that must be covered
by every health plan. All health plans sold at New York State of
Health must include them. Most plans sold elsewhere for
individuals and small businesses must also include them. The 10
"essential" services are:

Care at a doctor's office

Emergency services

Hospital care

Pregnant mother and baby care

Mental health and addiction treatment

Prescription drugs

Rehab and skill development services and devices

Lab services

Prevention & wellness services and long-lasting disease
management

Dental and vision care for children

What kinds of health plans are offered on the
Marketplace?

All health plans offered by New York State of Health are
licensed and approved by New York State. These plans are called
Qualified Health Plans. New Yorkers can also apply for public
programs such as Medicaid and Child Health Plus. If you qualify
for one of these programs, you can sign up right away.

Do I have a choice of health plans and medical providers?

You can choose from many Qualified Health Plans at New York
State of Health. We provide you with all the facts about each
one. This helps you choose a plan that is best for you and your
family. We also let you know which providers (like doctors and
hospitals) are part of each health plan.

What is a metal tier?

Health plans offered in the Marketplace will fall into
categories called metal tiers. The metal tiers are bronze,
silver, gold and platinum, and are associated with an actuarial
value. Actuarial value is the percentage of total average costs
for covered benefits that a plan will cover. For example, if a
plan has an actuarial value of 70%, the consumer would be
responsible for, on average, 30% of the costs of all covered
benefits. However, you could be responsible for a higher or lower
percentage of the total costs of covered services for the year,
depending on your actual health care needs and the terms of your
insurance policy. Platinum provides the highest level of
coverage, followed by gold, silver and bronze.

Public Input FAQ

How does the Marketplace involve the public in its
decision-making process?

The Marketplace has groups of community members and health
industry experts in five regions of the state. These groups give
advice to the Marketplace staff at meetings held throughout the
state. You can attend these meetings in-person if you wish or by
watching "webcasts" online. You can find information
about the time and place of the meetings and webcasts on this
website.

About This Site

This is the official Website of NY State of Health The
Official Health Plan Marketplace